Minimal Gas Vitrectomy for Retinal Detachment Repair

In this video, Drs. Rajeev Muni and Natalia Figueiredo describe minimal gas vitrectomy (MGV) for primary rhegmatogenous retinal detachment repair to achieve high integrity retinal attachment (HIRA). Retinal displacement can occur in up to 40% to 50% of patients following vitrectomy, likely because of the buoyant force of the large gas bubble leading to a stretch of the retina. This technique can minimize retinal displacement by avoiding drainage of subretinal fluid (SRF) and air-fluid exchange with the intravitreal injection of 0.6 cc of pure SF6 gas and immediate initial face down positioning. Although pneumatic retinopexy should be considered as a first-line treatment in patients meeting PIVOT trial criteria, MGV may be preferable to standard PPV, with a greater chance of HIRA, for certain cases such as those with limited preoperative view (e.g., vitreous hemorrhage, capsular phimosis, small pupil) or patients with no visible preoperative breaks who are found to meet PIVOT criteria intraoperatively.

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